Search

Copyright of Ethik in der Medizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article focuses on drawing lessons from the fourth decade of the HIV epidemic and the fourth year of the COVID-19 pandemic. It discusses the initial uncertainties and panic in responding to a new pathogen, the challenges of "instant epidemiology" in the age of social media, and the shift from behavioral prevention to biomedical approaches in both HIV and COVID-19 pandemics.

In all Western countries, the vaccination campaign against COVID-19 encountered some resistance. To overcome vaccine inertia and hesitancy, governments have used a variety of strategies and policy instruments. These instruments can be placed on a 'ladder of intrusiveness', starting from voluntary tools based on simple information and persuasion, through material incentives and disincentives of varying nature and magnitude, to highly coercive tools, such as lockdown for the unvaccinated and the introduction of the vaccination mandate. Italy's experience during the vaccination campaign against Covid provides an ideal observational point for starting to investigate this issue: not only was Italy among the top countries with the highest percentage of people vaccinated at the beginning of 2022, but—at least compared to other European countries—it was also one of the countries that had gradually introduced the most intrusive measures to increase vaccination compliance. In the article the different steps of the 'intrusiveness ladder' are presented, providing examples from various countries, and then tested on the Italian Covid-19 vaccination campaign between 2021 and the first months of 2022. For each phase of the campaign, the instrument mixes adopted by the Italian government are described, as well as the contextual conditions that led to their adoption. In the final section, an assessment of the composition and evolution of the Italian vaccination strategy is provided, based on the following criteria: legitimacy, feasibility, effectiveness, internal consistency and strategic coherence. Conclusions highlight the pragmatic approach adopted by the Italian government and underline the effects—both positive and negative—of scaling up the intrusiveness ladder. [ABSTRACT FROM AUTHOR]

Despite the outstanding progress that has been made in the prevention, detection, and management of hepatitis B during the past decades, hepatitis B remains a problem among healthcare personnel (HCP) in many countries. We reviewed studies on all aspects of hepatitis B in HCP published from 2017 through April 2023. They revealed wide variations on the prevalence of infection among HCP, ranging from 0.6% in Europe to >8.7% in Africa, almost always in association with very low vaccination rates. Many studies found a significant association between HCP's knowledge about hepatitis B and hepatitis B vaccines, their vaccination status, and practices. This research also discloses global inequities regarding vaccination policies against hepatitis B, free-of-charge vaccinations, and access to post-exposure prophylaxis (PEP). Strategies to prevent and manage accidental exposures are needed in order to reduce the burden of hepatitis B on HCP, while written policies for all aspects of infection prevention, protective equipment, and PEP should be available. Lastly, HCP should be accordingly educated. These are all imperative given the decline of routine vaccinations in the COVID-19 era, particularly in countries with fragile vaccination programs, and the disruptions of interventions for hepatitis B that are expected to provide a pool of virus transmission to future generations. [ABSTRACT FROM AUTHOR]

Public health policies designed to improve individual and population health may involve coercion. These coercive policies require ethical justification, and yet it is unclear in the public health ethics literature which ethical concepts might justify coercion, and what their limitations are in applying across contexts. In this paper, we analyse a number of concepts from Western bioethics, including the harm principle, paternalism, the public interest, and a duty of easy rescue. We find them plausible justifications for coercion in theory, but when applied to case studies, including HIV testing in Malawi, vaccine mandates in South Africa, and prohibitions of antibiotic use in livestock in the EU, their limitations become clear. We argue that the context-specificity of ethical justifications for coercion has been overlooked, and there is more work needed to identify context-relevant ethical justifications for coercive policies in various settings and for various populations, rather than relying on universalising Western bioethical justifications across all contexts., (© 2024. The Author(s).)

The recently derived Hybrid-Incidence Susceptible-Transmissible-Removed (HI-STR) prototype is a deterministic compartment model for epidemics and an alternative to the Susceptible-Infected-Removed (SIR) model. The HI-STR predicts that pathogen transmission depends on host population characteristics including population size, population density and social behaviour common within that population. The HI-STR prototype is applied to the ancestral Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) to show that the original estimates of the Coronavirus Disease 2019 (COVID-19) basic reproduction number R 0 for the United Kingdom (UK) could have been projected onto the individual states of the United States of America (USA) prior to being detected in the USA. The Imperial College London (ICL) group's estimate of R 0 for the UK is projected onto each USA state. The difference between these projections and the ICL's estimates for USA states is either not statistically significant on the paired Student t-test or not epidemiologically significant. The SARS-CoV2 Delta variant's R 0 is also projected from the UK to the USA to prove that projection can be applied to a Variant of Concern (VOC). Projection provides both a localised baseline for evaluating the implementation of an intervention policy and a mechanism for anticipating the impact of a VOC before local manifestation. [ABSTRACT FROM AUTHOR]

People with HIV (PWH) incur a higher risk of COVID-19-related morbidity and mortality rates, yet less is known about COVID-19 vaccine uptake and hesitancy in this group. We conducted a cross-sectional study in Freetown, Sierra Leone, from April to June 2022, using the VAX scale, a validated instrument, to assess attitudes towards COVID-19 vaccination and calculate the hesitancy (VAX) scores. We used generalized linear models to identify the factors associated with vaccine hesitancy. Overall, 490 PWH were enrolled (71.4% female, median age: 38 years, median CD4 count: 412 cells/mm3). About 17.3% received ≥1 dose of a COVID-19 vaccine. The mean VAX score was 43.14 ± 7.05, corresponding to 59.9% participants being vaccine-hesitant. A preference for natural immunity (65.8%) and concerns about profiteering (64.4%) were the commonest reasons for hesitancy, followed by a mistrust of vaccine benefits (61.4%) and worries about future effects (48.0%). In the adjusted regression analysis, being a Muslim (β = 2.563, p < 0.001) and having an urban residence (β = 1.709, p = 0.010) were associated with greater vaccine hesitancy, while testing for COVID-19 was associated with reduced vaccine hesitancy (β = −3.417, p = 0.027). These findings underscore the importance of addressing vaccine hesitancy as a critical element boosting COVID-19 vaccine uptake among PWH. [ABSTRACT FROM AUTHOR]

Background: The effects of the COVID-19 pandemic were more pronounced among migrants than in the majority population and went beyond those directly caused by the virus. Evidence suggests that this overburden is due to complex interactions between individual and structural factors. Some groups of working migrants were in vulnerable positions, overrepresented in essential jobs, under precarious work conditions, and ineligible for social benefits or special COVID-19 economic assistance. This study aimed to explore the experience of migrants working in Norway during the COVID-19 pandemic to gather an in-depth understanding of the pandemic´s impact on their health and well-being, focusing on occupation-related factors. Methods: In-depth personal interviews with 20 working migrants from different job sectors in Bergen and Oslo were conducted. Recruitment was performed using a purposive sampling method. Thematic analysis was used. Results: At the workplace level, factors such as pressure to be vaccinated, increased in occupational hazards, and increased structural discrimination negatively impacted migrants' health. Other factors at the host country context, such as changes in social networks in and out of the workplace and changes in the labour market, also had a negative effect. However, the good Norwegian welfare system positively impacted migrants' well-being, as they felt financially protected by the system. Increased structural discrimination was the only factor clearly identified as migrant-specific by the participants, but according to them, other factors, such as changes in social networks in and out of the workplace and social benefits in Norway, seemed to have a differential impact on migrants. Conclusions: Occupational-related factors affected the health and well-being of working migrants during the pandemic. The pressure to get vaccinated and increased structural discrimination in the workplace need to be addressed by Norwegian authorities as it could have legal implications. Further research using intersectional approaches will help identify which factors, besides discrimination, had a differential impact on migrants. This knowledge is crucial to designing policies towards zero discrimination at workplaces and opening dialogue arenas for acknowledging diversity at work. [ABSTRACT FROM AUTHOR]

The prevention of SARS-CoV-2 acquisition and transmission among healthcare workers is an ongoing challenge. Vaccination has been introduced to mitigate these risks. Vaccine uptake varies among healthcare workers in the absence of vaccine mandates. We investigated engagement with SARS-CoV-2 vaccination among healthcare workers and identified characteristics associated with lower vaccine uptake. This multi-site cross-sectional study recruited n = 1260 healthcare workers in both clinical and non-clinical roles over a three-month period from November 2022. Participants reported their engagement with the primary SARS-CoV-2 vaccination programme and subsequent booster programmes, as well as providing demographic, occupational and personal medical history information. Multivariable linear regression identified characteristics associated with vaccine uptake. Engagement with vaccination programmes was high, with 88% of participants receiving at least one booster dose after primary vaccination course. Younger age and female sex were associated with reduced vaccine uptake. Healthcare workers in non-clinical roles also had reduced vaccine uptake. These findings should inform vaccination strategies across healthcare settings and target populations with reduced vaccine uptake directly, in particular young, female, and non-clinical healthcare workers, both for SARS-CoV-2 and other healthcare-associated vaccine-preventable infections. [ABSTRACT FROM AUTHOR]

Purpose: Charity shops have met a number of challenges in light of the impacts of the Covid-19 pandemic. The paper aims to explore the economic and social impact of charity shops and reviews the transformative impact they have on place, the experience of place and the social environment. Design/methodology/approach: The paper conducts a review of the extant literature in the field of charity shop retail. Considering the issues that are raised, the article proceeds to discuss the opportunities that arise for place marketing efforts and charity shops in the retail environment, the wider sector, the high street and as a positive, key component of place(s). Findings: The paper provides novel sectorial insights and recommendations that can be adopted by charity retail outlets. This includes discussion on transformative place marketing, the experience of place and the charity shop' role in the social environment beyond the existing references to charity shops in place(s) and the high street. Originality/value: Charity shops play a vital role in society and yet they are an under researched field. The paper contributes knowledge on the role of charity shops in transforming and experiencing place. The paper concludes with observations made from the discussion on charity shops, and states areas for future research regarding the role of the charity shop and place marketing, place identity and transformation. [ABSTRACT FROM AUTHOR]

Background: Responses to COVID-19 in Canadian postsecondary education have overhauled usual norms and practices, with policies of unclear rationale implemented under the pressure of a reported public health emergency. Objective: To critically appraise the decision-making process informing COVID-19 policy in the postsecondary education sector. Methods: Our scoping review will draw from macro and micro theories of public policy, specifically the critical tradition exemplified by Carol Bacchi’s approach “What is the problem represented to be” and will be guided by Arksey and O’Malley’s framework for scoping reviews and the team-based approach of Levan and colleagues. Data will include diverse and publicly available documents to capture multiple stakeholders’ perspectives on the phenomenon of interest and will be retrieved from university newsletters and legal websites using combinations of search terms adapted to specific data types. Two reviewers will independently screen, chart, analyze and synthesize the data. Disagreements will be resolved through full team discussion. Discussion: Despite the unprecedented nature of the mass medical mandates implemented in the postsecondary sector and their dramatic impact on millions of lives-students, faculty, staff and their families, friends and communities-the decision-making process leading to them has not been documented or appraised. By identifying, summarizing and appraising the evidence, our review should inform practices that can contribute to effective and equitable public health policies in postsecondary institutions moving forward. [ABSTRACT FROM AUTHOR]

Introduction: Despite a high number of recorded COVID-19 infections and deaths in South Africa, COVID-19 vaccine coverage remained low in March 2022, ten months into the national vaccine roll-out. This study provides evidence on the correlates of vaccine intentions, attitudes towards vaccination and opinions about mandates. Methods: We used data from the second COVID-19 Vaccine Survey (CVACS), a telephone survey conducted February-March 2022 among 3,608 South African adults who self-reported not being vaccinated against COVID-19. The survey instrument was designed in consultation with government, policymakers, and civil society; and segmented the sample into four distinct groups with different vaccine intentions (synonymous with vaccine hesitancy levels). Kruskal-Wallis and Mann-Whitney tests were used to examine the sociodemographic characteristics, attitudes and behaviours associated with the different vaccination intentions groups. Thematic coding of responses to open-ended questions elicited insights on reasons for not being vaccinated and attitudes towards mandates. Results: Intentions to get vaccinated were greater among individuals with lower socio-economic status (Mann–Whitney Z = -11.3, p < 0.001); those believing the vaccine protects against death (Kruskal–Wallis Χ2 = 494, p < 0.001); and those who perceived themselves at risk of COVID-19-related illness (Χ2 = 126, p < 0.01). Vaccine intentions were lower among individuals who believed that the vaccine causes death (Χ2 = 163, p < 0.001); believed that the vaccine is unsafe for the babies of pregnant/breastfeeding mothers, or the chronically ill (Χ2 = 123, p < 0.01); those not trusting government health information about COVID-19 and the COVID-19 vaccine (Kendall's τ = -0.41, p < 0.01); and those in opposition to mandates (τ = 0.35, p < 0.001). Only 25% supported mandates, despite 48% thinking mandates would work well, with 54% citing individual rights as their main reason for mandate opposition. Conclusion: The profile of individuals not vaccinated against COVID-19 as of March 2022 varied markedly by self-reported vaccination intentions, underscoring the importance of tailored demand-creation efforts. This paper highlights several factors which differ significantly across these groups. These findings could inform the design of future vaccination campaigns, potentially increasing their likelihood of success. This is an important policy objective given widespread vaccine hesitancy, and further work is required on this topic. Mandates remain an option to increase coverage but need to be carefully considered given extensive opposition. [ABSTRACT FROM AUTHOR]

Vaccination has been the most effective way to control the outbreak of the COVID-19 pandemic. The numbers and types of vaccines have reached considerable proportions, even if the question of vaccine procedures and frequency still needs to be resolved. We have come to learn the necessity of defining vaccination distribution strategies with regard to COVID-19 that could be used for any future pandemics of similar gravity. In fact, vaccine monitoring implies the existence of a strategy that should be measurable in terms of input and output, based on a mathematical model, including death rates, the spread of infections, symptoms, hospitalization, and so on. This paper addresses the issue of vaccine diffusion and strategies for monitoring the pandemic. It provides a description of the importance and take up of vaccines and the links between procedures and the containment of COVID-19 variants, as well as the long-term effects. Finally, the paper focuses on the global scenario in a world undergoing profound social and political change, with particular attention on current and future health provision. This contribution would represent an example of vaccination experiences, which can be useful in other pandemic or epidemiological contexts. [ABSTRACT FROM AUTHOR]

(1) Background: Immunisation is a crucial and effective method for preventing infectious diseases, with its success dependent on high immunisation rates to protect under-immunised individuals and promote herd immunity. This qualitative descriptive study is part of a larger explanatory sequential mixed method design that aims to explore factors influencing parents' decision making to complete childhood immunisation in the Eastern Province of Saudi Arabia, a country experiencing disparities in immunisation coverage across its population. (2) Methods: The sample consisted of a subset of participants from the initial quantitative phase, which included a survey on the immunisation attitudes of parents living in Qatif. This initial phase included n = 350 participants, who were over 18, had access to one of the 27 Primary Health Care (PHC) Centres in Qatif, and had a child under 24 months. This paper presents the qualitative–descriptive phase, which used a qualitative survey to gain open-ended responses from parents (n = 20) and analysed using thematic analysis. (3) Results: Participants identified certain vaccines, particularly MMR, as influencing their immunisation practices. Specific factors identified as deterring parents from immunising their children included fear of autism and other developmental delays, concerns about risks and side effects, mistrust in vaccine efficacy, and discouraging information from the media. Parents' immunisation decisions were evidently affected by policy compliance, family and friends, and social networking sites. These factors are explained through the socio-ecological model. Moreover, the COVID-19 pandemic influenced parents' decisions on vaccine completion in terms of perceived barriers, perceived benefits, and perceived trust. (4) Conclusions: By examining the social–ecological factors shaping parents' decisions to immunise their children in the Eastern Province of Saudi Arabia, this research contributes to the literature and informs the Saudi National Childhood Immunisation Programme about factors contributing to childhood immunisation hesitancy, helping to address a critical healthcare issue. [ABSTRACT FROM AUTHOR]

Background: Despite the demonstrated efficacy of approved COVID‐19 vaccines, high levels of hesitancy were observed in the first few months of the COVID‐19 vaccines' rollout. Factors contributing to vaccine hesitancy are well‐described in the literature. Among the various strategies for promoting vaccine confidence, educational interventions provide a foundationally and widely implemented set of approaches for supporting individuals in their vaccine decisions. However, the evidence around the measurable impact of various educational strategies to improve vaccine confidence is limited. We conducted a scoping review with the aim of exploring and characterizing educational interventions delivered during the pandemic to support COVID‐19 vaccine confidence in adults. Methods: We developed a search strategy with a medical information scientist and searched five databases, including Ovid MEDLINE and Web of Science, as well as grey literature. We considered all study designs and reports. Interventions delivered to children or adolescents, interventions on non‐COVID‐19 vaccines, as well as national or mass vaccination campaigns without documented interaction(s) between facilitator(s) and a specific audience were excluded. Articles were independently screened by three reviewers. After screening 4602 titles and abstracts and 174 full‐text articles across two rounds of searches, 22 articles met our inclusion criteria. Ten additional studies were identified through hand searching. Data from included studies were charted and results were described narratively. Results: We included 32 studies and synthesized their educational delivery structure, participants (i.e., facilitators and priority audience), and content. Formal, group‐based presentations were the most common type of educational intervention in the included studies (75%). A third of studies (34%) used multiple strategies, with many formal group‐based presentations being coupled with additional individual‐based interventions (29%). Given the novelty of the COVID‐19 vaccines and the unique current context, studies reported personalized conversations, question periods, and addressing misinformation as important components of the educational approaches reviewed. Conclusions: Various educational interventions were delivered during the COVID‐19 pandemic, with many initiatives involving multifaceted interventions utilizing both formal and informal approaches that leveraged community (cultural, religious) partnerships when developing and facilitating COVID‐19 vaccine education. Train‐the‐trainer approaches with recognized community members could be of value as trust and personal connections were identified as strong enablers throughout the review. [ABSTRACT FROM AUTHOR]

Previous studies have demonstrated an association between low personal protective equipment (PPE) availability and high stress and anxiety among frontline healthcare workers during the COVID-19 pandemic. It is unclear how other factors, such as infection prevention and control (IPC) training and IPC policy support, correlate with workers' distress. The current study explores these relationships. We conducted a secondary analysis of a public survey dataset from Statistics Canada. Acute care workers' survey responses (n = 7379) were analyzed using structural equation modeling to examine relationships between features of the IPC work environment and acute care workers' ratings of their stress and mental health. We found that PPE availability (β = −0.16), workplace supports (i.e., training, IPC policy compliance, and enforcement) (β = −0.16), and support for staying home when sick (β = −0.19) were all negatively correlated with distress. Together, these features explained 18.4% of the overall variability in workers' distress. Among surveyed acute care workers, PPE availability was related to their distress; however, having workplace support and an emphasis on staying home when sick was also relevant. Overall, the results highlight that, in addition to PPE availability, workplace supports and emphasis on staying home are important. IPC professionals and healthcare leaders should consider these multiple features as they support acute care workers during future infectious disease outbreaks. [ABSTRACT FROM AUTHOR]

A large proportion of children do not receive vaccines within the recommended timeframe. This study examined ethnic and socioeconomic differences in age-appropriate immunization of children in Israel, where immunization is freely available. Percent of children receiving MMR/V at 12–13 months, and four doses of DTP/IPV/Hib by 18 months were obtained from the National Programme for Quality Measures between 2015 and 2018. Ethnic group (Jewish vs Arab) (defined by proxy by the neighbourhood in which the clinic was located), neighbourhood socioeconomic status and peripherality were obtained. Rates of MMR vaccination were 61% in the Jewish and 82% in the Arab population; for DPT/IPV/Hib 75% in the Jewish, compared to 92% in the Arab population. These patterns were stable over time. Lowest rates occurred in the most peripheral areas for Arab children, and in urban areas for Jewish children. Differences between ethnic groups were significant at higher SES levels. Greater adherence to the vaccination schedule occurred in the Arab minority in contrast to studies showing lower vaccination in ethnic minorities elsewhere. Lower immunization rates among rural Arab children suggest a need for improved access to clinics. Efforts should be directed towards lower SES groups, while emphasizing the importance of timely vaccination in wealthier groups in order to achieve herd immunity. [ABSTRACT FROM AUTHOR]

The uptake of COVID-19 vaccines is critical to address the severe consequences of the disease. Previous studies have suggested that many healthcare workers (HCWs) are hesitant to receive the COVID-19 vaccine, further enhancing hesitancy rates within countries. COVID-19 vaccine acceptance and hesitancy levels are currently unknown among HCWs in Zambia, which is a concern given the burden of infectious diseases in the country. Consequently, this study assessed COVID-19 vaccine acceptance and hesitancy among HCWs in Lusaka, Zambia. A cross-sectional study was conducted among 240 HCWs between August and September 2022, using a semi-structured questionnaire. Multivariable analysis was used to determine the key factors associated with vaccine hesitancy among HCWs. Of the 240 HCWs who participated, 54.2% were females. A total of 72.1% of the HCWs would accept being vaccinated, while 27.9% were hesitant. Moreover, 93.3% of HCWs had positive attitudes towards COVID-19 vaccines, with medical doctors having the highest mean attitude score (82%). Encouragingly, HCWs with positive attitudes towards COVID-19 vaccines had reduced odds of being hesitant (AOR = 0.02, 95% CI: 0.01–0.11, p < 0.001). Overall, acceptance of the COVID-19 vaccine among HCWs in Lusaka, Zambia, was high, especially by those with positive attitudes. However, the current hesitancy among some HCWs is a concern. Consequently, there is a need to address this and encourage HCWs to fully promote vaccination programs going forward. [ABSTRACT FROM AUTHOR]

With the Omicron wave, SARS-CoV-2 infections improved, with less lung involvement and few cases of severe manifestations. In this pictorial review, there is a summary of the pathogenesis with particular focus on the interaction of the immune system and gut and lung axis in both pulmonary and extrapulmonary manifestations of COVID-19 and the computed tomography (CT) imaging features of COVID-19 pneumonia from the beginning of the pandemic, describing the typical features of COVID-19 pneumonia following the Delta variant and the atypical features appearing during the Omicron wave. There is also an outline of the typical features of COVID-19 pneumonia in cases of breakthrough infection, including secondary lung complications such as acute respiratory distress disease (ARDS), pneumomediastinum, pneumothorax, and lung pulmonary thromboembolism, which were more frequent during the first waves of the pandemic. Finally, there is a description of vascular extrapulmonary complications, including both ischemic and hemorrhagic abdominal complications. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B virus (HBV) vaccination is indicated for all end stage kidney disease patients, including all solid organ transplant candidates. Maintenance of adequate immunity is especially important for immunosuppressed solid organ recipients who are at increased risk for donor or community acquired HBV. The impact of age and immunosuppression on long‐term maintenance of HBV immunity postvaccination has not been fully investigated. Methods: We performed a single‐center retrospective study of 96 kidney transplant recipients, transplanted between July 2012 and December 2020, who had Hepatitis B surface antibody (HBsAb) levels measured pretransplantation and 1‐year posttransplantation. We compared the change in HBsAb levels stratified by patient's age (<45, 45–60, and >60) and by whether or not the patient received lymphocyte depleting induction therapy. Results: Our results demonstrate that HBsAb IgG levels vary by age group, decreased significantly at 1‐year posttransplant (p <.0001) and were significantly lower in the older cohort (p =.03). Among recipients who received rabbit anti‐thymocyte globulin induction (rATG), the log HbsAb levels were significantly lower in the older age group (2.15 in age <45, 1.75 in age 45–60 and 1.47 in age >60, p =.01). Age group (p =.004), recipient HBcAb status (p =.002), and rATG (p =.048) were independently associated with >20% reduction in log HBsAb levels posttransplant. Conclusion: Significant declines in HBsAb levels occur postkidney transplantation, especially in older individuals, thus placing exposed older kidney transplant recipients at greater risk of HBV infection and associated complications. [ABSTRACT FROM AUTHOR]

This paper offers an explanation for subjects' lack of confidence in vaccines' safety, which in turn is widely recognized as one of the main determinants of vaccine hesitancy. I argue that among the psychological roots of this lack of confidence there is a kind of intuitive thinking that can be traced back to a specific superstitious belief: the belief that "it is bad luck to tempt fate". Under certain conditions, subjects perceive the choice to undergo vaccinations as an action that "tempts fate", and this leads them to overestimate its risks. When an action is perceived as "tempting fate", indeed, its possible negative outcomes are anticipated as highly aversive, and as such they capture subjects' imagination, thereby feeling more subjectively probable. This has important consequences for practical pro-vaccine interventions. Part of what makes an action perceived as "tempting fate" is its being free, arbitrary, and departing from one's typical behavior: insofar as vaccine hesitancy is driven by beliefs about tempting fate, then, we can predict the success of interventions that make vaccinations nearly mandatory, or build vaccination opportunities into health care routines as opt-out, rather than opt-in options, making them closer to something that subjects passively accept rather actively seek. [ABSTRACT FROM AUTHOR]

Despite the proven safety and clinical efficacy of the Measles vaccine, many countries are seeing new heights of vaccine hesitancy or refusal, and are experiencing a resurgence of measles infections as a consequence. With the use of novel machine learning tools, we investigated the prevailing negative sentiments related to Measles vaccination through an analysis of public Twitter posts over a 5-year period. We extracted original tweets using the search terms related to "measles" and "vaccine," and posted in English from January 1, 2017, to December 15, 2022. Of these, 155,363 tweets were identified to be negative sentiment tweets from unique individuals, through the use of Bidirectional Encoder Representations from Transformers (BERT) Named Entity Recognition and SieBERT, a pretrained sentiment in English analysis model. This was followed by topic modeling and qualitative thematic analysis performed inductively by the study investigators. A total of 11 topics were generated after applying BERTopic. To facilitate a global discussion of results, the topics were grouped into four different themes through iterative thematic analysis. These include (a) the rejection of "anti-vaxxers" or antivaccine sentiments, (b) misbeliefs and misinformation regarding Measles vaccination, (c) negative transference due to COVID-19 related policies, and (d) public reactions to contemporary Measles outbreaks. Theme 1 highlights that the current public discourse may further alienate those who are vaccine hesitant because of the disparaging language often used, while Themes 2 and 3 highlight the typology of misperceptions and misinformation underlying the negative sentiments related to Measles vaccination and the psychological tendency of disconfirmation bias. Nonetheless, the analysis was based solely on Twitter and only tweets in English were included; hence, the findings may not necessarily generalize to non-Western communities. It is important to further understand the thinking and feeling of those who are vaccine hesitant to address the issues at hand. [ABSTRACT FROM AUTHOR]

Despite the availability of the coronavirus disease 2019 (COVID-19) vaccination, uptake among pregnant women in Sub-Saharan Africa has been low. This scoping review aimed to identify and characterize determinants influencing COVID-19 vaccination decision-making behaviors among pregnant women in Sub-Saharan Africa. We searched five online databases for articles on COVID-19 vaccination among pregnant women in Sub-Saharan Africa. We identified studies published in English between March 2020 and April 2023 that assessed vaccine-specific issues, psychosocial constructs, and contextual factors associated with COVID-19 vaccination decision-making behaviors. Of the fourteen studies identified, over half (57.1%) were cross-sectional; three used qualitative research methods; and three involved multi-country participants. Most studies assessed COVID-19 vaccination acceptability and willingness. Overall, 85.7% of the publications examined knowledge, attitudes, or both as critical factors associated with COVID-19 vaccination. The prevalence of COVID-19 vaccine uptake during pregnancy was low in Sub-Saharan Africa (14.4–28%). While most current studies assess COVID-19 vaccination knowledge, research on maternal vaccination in Sub-Saharan Africa would benefit from the inclusion of theory-informed and driven studies that measure additional psychosocial factors and contextual constructs. Future studies should also employ study designs that can determine causal pathways of vaccination determinants and vaccination uptake. [ABSTRACT FROM AUTHOR]

(1) Background: France implemented a COVID-19 certificate in July 2021 to incentivize the population to uptake COVID-19 vaccines. However, little is known about the variation in its impact across age groups and its dependence on socio-demographic, economic, logistic, or political factors. (2) Methods: Using France's weekly first dose vaccination rate, a counterfactual trend approach allowed for the estimation of the vaccination rate across age groups at a small geographical level before and after the implementation of the health pass. The effect of the health pass was operationalized as the vaccination rate among those who would not be vaccinated without it. (3) Results: Vaccination before the health pass varied greatly among age groups and was mainly influenced by territory (lower in rural and overseas territories when compared to urban and metropolitan ones), political beliefs, and socio-economic disparities. Vaccine logistics played a minor but significant role, while the impact of COVID-19 did not affect the vaccination rate. The health pass increased the vaccination overall but with varying efficiency across groups. It convinced mainly young people politically close to the governmental vaccination strategy and living in urban metropolitan areas with low socio-economical discrepancies. The selected variables explained most of the variability of the vaccination rate before the health pass; they explained, at most, a third of the variation in the health pass effect on vaccination. (4) Conclusions: From a public health perspective, the French health pass increased the overall vaccination, but failed to promote preventive behaviours in all segments of society, particularly in vulnerable communities. [ABSTRACT FROM AUTHOR]

Vaccination against life-threatening infectious illnesses is an important medical contribution that saves millions of lives worldwide each year. However, vaccine development and its use often attracted significant ethical controversies. The ethical deliberations around vaccine research and use often utilize public health ethics principles where the benefit of the community at large or the common good is considered as the goal of ethical deliberations over benefits at the individual level. A scoping review of the literature regarding mandatory COVID-19 vaccination showed that many scholars recommended such a strategy based on the harm principle, and there is not much literature regarding other ethical principles that can be utilized to promote mandatory COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

This community-based research examines the impact of the coronavirus disease of 2019 (COVID-19) pandemic on service provision to people experiencing homelessness and concurrent disorders (PEHCD) in British Columbia, Canada. Using mixed methods, 119 service providers from across BC participated in a survey, and of those, 25 participated in semi-structured interviews. Several gaps emerged in service delivery to PEHCD during the COVID-19 pandemic. Despite these challenges, service providers adapted to support their clients' needs, which included supporting new and expanding service groups: (a) people who were experiencing homelessness for the first time due to pandemicrelated job loss, (b) people who receive low incomes and are experiencing food insecurity, (c) more complex mental health needs, (d) seniors, (e) youth/students, and (f) family members fleeing violence in the home (e.g., intimate partner violence and child abuse). In the absence of Point-in-Time Counts in Canada during the COVID-19 pandemic as per physical distancing protocols, this data on new and expanding service groups highlights the critical need to embed considerations for social vulnerabilities and secondary impacts into pandemic planning and response efforts. [ABSTRACT FROM AUTHOR]

Although it is well-established that the highest forms of health and well-being are experienced by those who embody the greatest levels of autonomy, the Covid-19 pandemic disrupted autonomy and freedom in decision making, such as leading healthy lifestyles like physical activity, either because of disease-related issues (e.g., battling sickness and/or long covid or fear of catching covid 19) and/or governmentally imposed covid-19 mandates, such as lockdowns, social isolation, excessive screen use, face masks, and vaccines that proved to cause extensive harm and devastation in the health of the public. The paper draws on the philosophical underpinnings of embodied physical consciousness and body schema based on Merleau- Ponty's (1945/2014) existential freedom about decision making for living the good life. Specifically, based on Merleau-Ponty's seminal work, Phenomenology of Perception (1945/2014), the purpose of this conceptbased paper is to attempt to emphasize the importance of a strong, embodied body schema (motor habit) to freedom in decision making regarding the value of and participation in physical activity. The manuscript is divided into six sections, showcasing that such (total) freedom can be achieved by finding a balance between the body as being for itself (with consciousness and autonomy) and the body as being in the world --- influenced by external forces like disease (e.g., Covid 19), disability, socio-economic status, and sociopolitical systems (e.g., covid-19 mandates). Given the threats to total freedom (because of our being in the world), implications for the field of Kinesiology and movement education are discussed, emphasizing ways to build a healthy physical culture, by for example implementing well-studied, ethical, and humanistic policies/recommendations regarding life challenges (e.g., disease, disability, poverty). In this way, a strong body schema can be formed for health and well-being. [ABSTRACT FROM AUTHOR]

Background: Ethical reasoning and sensitivity are always important in public health, but it is especially important in the sensitive and complex area of public health emergency preparedness. Here, we explored the ethical challenges, and dilemmas encountered by frontline health workers amid the coronavirus disease-19 (COVID-19) pandemic in Ethiopia. Methods: A nationwide survey was conducted amongst the frontline health workers from nineteen public hospitals. Health workers were invited to respond to a self-administered questionnaire. Data were weighted and analyzed using descriptive statistics. Results: Of the 285 frontline health workers to whom questionnaires were distributed, 217 of them gave their responses (response rate 76.1%). Respondents frequently reported encountering rationing dilemmas on health commodities directly used for the prevention and treatment of COVID-19. Most (83.9%) of the health workers agreed that they encountered ethical challenges very frequently or frequently. Almost all [215(99.1%)] claimed that the limitation of resources was directly used for the treatment and prevention of COVID-19. The frequency of difficulty in the provision of essential clinical services varied between 77% and 98.7% for different services. More than half of the study participants reported that they had encountered difficulty in the provision of clinical care on a daily or weekly basis. Regarding rationing strategies, isolating COVID-19 treatment units and limiting admission were the most frequent rationing strategies used by two-thirds of health workers on a daily or weekly basis. Conclusion: Front-line health workers encountered numerous ethically challenging situations during COVID-19. More than half of health workers reported that they encountered ethical challenges in rationing the resources and delivery of different clinical services such as family planning services, maternal and childcare, immunization, and chronic care. With limited resources such as ventilators and hospital beds, healthcare providers have been faced with the difficult task of deciding who gets access to these resources and who doesn't. Overall, the COVID-19 pandemic has presented numerous ethical challenges for healthcare providers, highlighting the importance of ethical considerations in healthcare delivery. By being aware of these dilemmas and having policies in place to address them, healthcare providers can ensure that they are providing the best possible care to their patients while upholding ethical standards. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the impact of mandated vaccination policies on the primary care clinic workforce in the United States or differences between rural and urban settings, especially for COVID-19. With the continued pandemic and an anticipated increase in novel disease outbreaks and emerging vaccines, healthcare systems need additional information on how vaccine mandates impact the healthcare workforce to aid in future decision-making. Methods: We conducted a cross-sectional survey of Oregon primary care clinic staff between October 28, 2021– November 18, 2021, following implementation of a COVID-19 vaccination mandate for healthcare personnel. The survey consisted of 19 questions that assessed the clinic-level impacts of the vaccination mandate. Outcomes included job loss among staff, receipt of an approved vaccination waiver, new vaccination among staff, and the perceived significance of the policy on clinic staffing. We used univariable descriptive statistics to compare outcomes between rural and urban clinics. The survey also included three open-ended questions that were analyzed using a template analysis approach. Results: Staff from 80 clinics across 28 counties completed surveys, representing 38 rural and 42 urban clinics. Clinics reported job loss (46%), use of vaccination waivers (51%), and newly vaccinated staff (60%). Significantly more rural clinics (compared to urban) utilized medical and/or religious vaccination waivers (71% vs 33%, p = 0.04) and reported significant impact on clinic staffing (45% vs 21%, p = 0.048). There was also a non-significant trend toward more job loss for rural compared to urban clinics (53% vs. 41%, p = 0.547). Qualitative analysis highlighted a decline in clinic morale, small but meaningful detriments to patient care, and mixed opinions of the vaccination mandate. Conclusions: Oregon's COVID-19 vaccination mandate increased healthcare personnel vaccination rates, yet amplified staffing challenges with disproportionate impacts in rural areas. Staffing impacts in primary care clinics were greater than reported previously in hospital settings and with other vaccination mandates. Mitigating primary care staffing impacts, particularly in rural areas, will be critical in response to the continued pandemic and novel viruses in the future. [ABSTRACT FROM AUTHOR]

Background: The spread of misinformation of all types threatens people's safety and interrupts resolutions. COVID-19 vaccination has been a widely discussed topic on social media platforms with numerous misleading and fallacious information. This false information has a critical impact on the safety of society as it prevents many people from taking the vaccine, decelerating the world's ability to go back to normal. Therefore, it is vital to analyze the content shared on social media platforms, detect misinformation, identify aspects of misinformation, and efficiently represent related statistics to combat the spread of misleading information about the vaccine. This paper aims to support stakeholders in decision-making by providing solid and current insights into the spatiotemporal progression of the common misinformation aspects of the various available vaccines. Methods: Approximately 3800 tweets were annotated into four expert-verified aspects of vaccine misinformation obtained from reliable medical resources. Next, an Aspect-based Misinformation Analysis Framework was designed using the Light Gradient Boosting Machine (LightGBM) model, which is one of the most advanced, fast, and efficient machine learning models to date. Based on this dataset, spatiotemporal statistical analysis was performed to infer insights into the progression of aspects of vaccine misinformation among the public. Finally, the Pearson correlation coefficient and p-values are calculated for the global misinformation count against the vaccination counts of 43 countries from December 2020 until July 2021. Results: The optimized classification per class (i.e., per an aspect of misinformation) accuracy was 87.4%, 92.7%, 80.1%, and 82.5% for the "Vaccine Constituent," "Adverse Effects," "Agenda," "Efficacy and Clinical Trials" aspects, respectively. The model achieved an Area Under the ROC Curve (AUC) of 90.3% and 89.6% for validation and testing, respectively, which indicates the reliability of the proposed framework in detecting aspects of vaccine misinformation on Twitter. The correlation analysis shows that 37% of the countries addressed in this study were negatively affected by the spread of misinformation on Twitter resulting in reduced number of administered vaccines during the same timeframe. Conclusions: Twitter is a rich source of insight on the progression of vaccine misinformation among the public. Machine Learning models, such as LightGBM, are efficient for multi-class classification and proved reliable in classifying vaccine misinformation aspects even with limited samples in social media datasets. [ABSTRACT FROM AUTHOR]

(1) Background: During 2019, the COVID-19 pandemic was threatening healthcare services and workers, and acquiring immunity was an option to stop or limit the burden of this pandemic. Herd immunity was a top priority worldwide as the virus was spreading rapidly. It was estimated that 67% of the total global population should be immunized against COVID-19 to achieve herd immunity. The aim of the current study is to investigate different perceptions of healthcare workers in the Kingdom of Bahrain and Egypt using an online survey in an attempt to evaluate their awareness and concerns regarding new variants and booster doses. (2) Methods: This study conducted a survey on healthcare workers in the Kingdom of Bahrain and Egypt about their perception and concerns on the COVID-19 vaccines. (3) Results: The study found that out of 389 healthcare workers 46.1% of the physicians were not willing to take the booster doses (p = 0.004). Physicians also did not support taking the COVID-19 vaccine as an annual vaccine (p = 0.04). Furthermore, to assess the association between the type of vaccine taken with the willingness of taking a booster vaccine, healthcare workers beliefs on vaccine effectiveness (p = 0.001), suspension or contact with patients (p = 0.000), and infection after COVID-19 vaccination (p = 0.016) were significant. (4) Conclusion: Knowledge about vaccine accreditation and regulation should be dispersed more widely to ensure that the population has a positive perception on vaccine safety and effectiveness. [ABSTRACT FROM AUTHOR]

The early attainment of high COVID-19 vaccination rates can minimize avoidable hospitalizations/deaths. The fifth wave COVID-19 outbreak in Hong Kong caused >9000 deaths, and most of them were unvaccinated older people. This study hence investigated determinants of taking the first dose vaccination at a later phase (Phase 3: during the fifth wave outbreak, i.e., February–July 2022) versus two earlier phases (Phase 1: first six months since vaccine rollout, i.e., February–July 2021; Phase 2: six months prior to the outbreak, i.e., August 2021–January 2022) via a random telephone survey among 386 ever-vaccinated Hong Kong older people aged ≥60 (June/July 2022). A total of 27.7%, 51.1%, and 21.3% took the first dose at Phase 1, Phase 2, and Phase 3, respectively. Unfavorable perceptions related to COVID-19/vaccination, exposure to conflicting/counter-information about the suitability of older people's vaccination from various sources, unsupportive family influences prior to the outbreak, and depressive symptoms were significantly associated with taking the first dose at Phase 3 instead of Phase 1 and Phase 2. To speed up COVID-19 vaccination and avoid unnecessary deaths, the government and health professionals should rectify misinformation, provide clear/consistent information for older people and their family members, and focus on those having depressive symptoms at an earlier stage of the pandemic. [ABSTRACT FROM AUTHOR]

The COVID crisis of the past three years has greatly impacted stakeholder relationships between scientists, health providers, policy makers, pharmaceutical industry employees, and the public. Lockdowns and restrictions of civil liberties strained an already fraught relationship between the public and policy makers, with scientists also seen as complicit in providing the justification for the abrogation of civil liberties. This was compounded by the suppression of open debate over contentious topics of public interest and a violation of core bioethical principles embodied in the Nuremberg Code. Overall, the policies chosen during the pandemic have had a corrosive impact on public trust, which is observable in surveys and consumer behaviour. While a loss of trust is difficult to remedy, the antidotes are accountability and transparency. This narrative review presents an overview of key issues that have motivated public distrust during the pandemic and ends with suggested remedies. Scientific norms and accountability must be restored in order to rebuild the vital relationship between scientists and the public they serve. [ABSTRACT FROM AUTHOR]

Copyright of Social Science Information is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: This study was designed to examine the relationship between humble leadership and nurses' turnover intention and investigate the moderating role of leader expertise in this relationship., Background: Leader humility and expertise are two key dimensions of professional spirit in competitive magnet organizations. Many organizational factors could make nurses take a decision to leave their organization; however, leader humility and expertise could help nurses retract from this decision., Method: This is a multisite cross-sectional study that was conducted at all medical-surgical units of four university hospitals. Using scales for assessing leader humility, nurses' turnover intention, and leader expertise, 385 nurses were surveyed. Data were investigated via descriptive and inferential statistics, where correlation, path analysis, and structured equation modeling were used to test the hypothetical relationship among study variables., Results: There is a statistically significant negative relationship between humble leadership and nurses' turnover intention. Humble leadership and leader expertise were significant predictors of nurses' turnover intention. The moderating effect of leader expertise on the relationship between humble leadership and nurses' turnover intention was statistically significant, making it more negative, implying that leader expertise amplifies the effect of leader humility on reducing nurses' turnover., Conclusion: Incorporating leader expertise with humility could provide an efficient panacea for reducing turnover intentions among nurses in different healthcare organizations., Implications for Nursing and Health Policy: Healthcare organizations could develop an efficient retention plan for nurses by cultivating humility among both leaders and nurses. In addition, building nurse leaders' expertise through opening avenues for professional development is a good strategy in the face of nurses' shortage and high turnover. Furthermore, succession planning in healthcare organizations must consider humility as a vital skill among anticipated leaders., (© 2024 International Council of Nurses.)

Background: The success of the COVID-19 vaccination roll-out depended on clear policy communication and guidance to promote and facilitate vaccine uptake. The rapidly evolving pandemic circumstances led to many vaccine policy amendments. The impact of changing policy on effective vaccine communication and its influence in terms of societal response to vaccine promotion are underexplored; this qualitative research addresses that gap within the extant literature. Methods: Policy communicators and community leaders from urban and rural Ontario participated in semi-structured interviews (N = 29) to explore their experiences of COVID-19 vaccine policy communication. Thematic analysis was used to produce representative themes. Results: Analysis showed rapidly changing policy was a barrier to smooth communication and COVID-19 vaccine roll-out. Continual amendments had unintended consequences, stimulating confusion, disrupting community outreach efforts and interrupting vaccine implementation. Policy changes were most disruptive to logistical planning and community engagement work, including community outreach, communicating eligibility criteria, and providing translated vaccine information to diverse communities. Conclusions: Vaccine policy changes that allow for prioritized access can have the unintended consequence of limiting communities' access to information that supports decision making. Rapidly evolving circumstances require a balance between adjusting policy and maintaining simple, consistent public health messages that can readily be translated into action. Information access is a factor in health inequality that needs addressing alongside access to vaccines. [ABSTRACT FROM AUTHOR]

Introduction: The global consequences of the COVID-19 pandemic cannot be overstated. Vaccinations are one of the leading strategies to protect against the virus, and it is likely that students' understanding and desire to be vaccinated can be major factors in helping contain the pandemic. Nonetheless, no studies looked into the vaccine attitude, knowledge and willingness in Namibia. Objectives: To assess and describe the association between knowledge, attitudes, and willingness of undergraduate students to receive COVID-19 vaccines in the school of education, nursing and economics and management science at the university campus in Namibia. Methods: The study employed a cross-sectional descriptive study from 200 undergraduate university students using a convenience sampling. Data analysis was done using SPSSv28 and descriptive statistics were used to depict trends in data while a Pearson's correlation determined the relationship between the study variables. Results: The data showed that 54.2% (1.54 ± 0.49) of the participants had adequate knowledge concerning the vaccine, while 57.1% and 58.6% had a negative outlook and were unwilling to get vaccinated. A moderate positive correlation was observed between attitudes and willingness to take COVID-19 vaccines (r =.546, P =<.001), while a negative relation existed between knowledge and attitudes (r = −.017, P =>.001). Conclusions: This study has provided valuable insight into the knowledge, attitudes, and willingness of undergraduate students to receive COVID-19 vaccines. Despite more than half of the participants having appropriate knowledge, they had an unfavourable outlook toward COVID-19 vaccination. It is recommended that further studies focus on how factors such as incentives, religion and cultural values affect their desires to be vaccinated. [ABSTRACT FROM AUTHOR]

During the ongoing multi-country monkeypox (Mpox) outbreak, healthcare workers (HCWs) have represented a key group in mitigating disease spread. The current study aimed to evaluate the attitude of nurses and physicians in Jordan towards Mpox vaccination, as well as their attitude towards compulsory vaccination against coronavirus disease 2019 (COVID-19), influenza, and Mpox. An online survey was distributed in January 2023 based on the previously validated 5C scale for psychological determinants of vaccination. Previous vaccination behavior was assessed by inquiring about the history of getting the primary and booster COVID-19 vaccination, influenza vaccine uptake during COVID-19, and any history of influenza vaccine uptake. The study sample consisted of 495 respondents: nurses (n = 302, 61.0%) and physicians (n = 193, 39.0%). Four hundred and thirty respondents (86.9%) had heard of Mpox before the study, and formed the final sample considered for Mpox knowledge analysis. Deficiencies in Mpox knowledge were reflected in a mean knowledge score of 13.3 ± 2.7 (out of 20.0 as the maximum score), with significantly lower knowledge among nurses and females. The intention to receive Mpox vaccination was reported by 28.9% of the participants (n = 143), while 33.3% were hesitant (n = 165), and 37.8% were resistant (n = 187). In multivariate analysis, Mpox vaccine acceptance was significantly associated with previous vaccination behavior, reflected in higher vaccine uptake and with higher 5C scores, while Mpox knowledge was not correlated with Mpox vaccination intention. The overall attitude towards compulsory vaccination was neutral, while a favorable attitude towards compulsory vaccination was associated with higher 5C scores and a history of previous vaccination uptake. The current study showed a low intention to get Mpox vaccination in a sample of nurses and physicians practicing in Jordan. The psychological factors and previous vaccination behavior appeared as the most significant determinants of Mpox vaccine acceptance and of attitudes towards compulsory vaccination. The consideration of these factors is central to policies and strategies aiming to promote vaccination among health professionals in efforts to prepare for future infectious disease epidemics. [ABSTRACT FROM AUTHOR]

The COVID-19 vaccination is a crucial public health intervention for controlling the spread and severity of the SARS-CoV2 virus. COVID-19 vaccines have been developed in record time, but their deployment has varied across countries, owing to differences in health system capacity, demand for the vaccine, and purchasing power of countries. The aim of this rapid review is to summarize and synthesize experiences on COVID-19 vaccine service delivery and integration to inform future COVID-19 vaccination programming and contribute to the knowledge base for future pandemic management. A systematic search was conducted in PubMed, Scopus, and Global Index Medicus databases. Twenty-five studies were included in the analysis. Included studies spanned nine countries where COVID-19 vaccines were delivered through mass, mobile, and fixed-post vaccination service delivery models. There was limited evidence of integrating COVID-19 vaccines into routine services for pregnant women, people who inject drugs, and leveraging existing health programs to deliver COVID-19 vaccines to the general population. Common challenges reported were vaccine skepticism, lack of adequate health workers, and linguistic barriers to access. Partnerships with a variety of stakeholders and the involvement of volunteers were vital in overcoming barriers and contributed to the efficient functioning of COVID-19 vaccination programs. [ABSTRACT FROM AUTHOR]

COVID-19 vaccine hesitancy continues to be a widespread problem in Pakistan due to various conspiracy beliefs, myths and misconceptions. Since the hemodialysis population is at a higher risk of contracting infections, we sought to investigate the current COVID-19 immunization status and reasons for any vaccine hesitancy among these patients in Pakistan. This cross-sectional study was conducted among maintenance hemodialysis patients at six hospitals in the Punjab Province of Pakistan. Data were collected anonymously using a questionnaire. A total of 399 hemodialysis patients took part in the survey, the majority of them were male (56%) and aged 45–64 years. A calculated 62.4% of the patients reported receiving at least one dose of the COVID-19 vaccine. Of those vaccinated (249), 73.5% had received two doses and 16.9% had received a booster dose. The most common reasons for vaccination were "being aware they were at high risk" (89.6%), "fear of getting infected" (89.2%) and "willingness to fight against COVID-19-pandemic" (83.9%). Of the 150 patients who had not yet been vaccinated, only 10 showed a willingness to take the COVID-19 vaccine. The major reasons for refusal included "COVID-19 is not a real problem" (75%), the "corona vaccine is a conspiracy (72.1%)" and "I don't need the vaccine" (60.7%). Our study revealed that only 62% patients receiving hemodialysis were partially or completely vaccinated against COVID-19. Consequently, there is a need to initiate aggressive approaches to educate this high-risk population in order to address their concerns with vaccine safety and efficacy as well as correct current myths and misconceptions to improve the COVID-19 immunization status in this population. [ABSTRACT FROM AUTHOR]

Pregnant women are more prone to experience severe COVID-19 disease, including intensive care unit (ICU) admission, use of invasive ventilation, extracorporeal membrane oxygenation (ECMO), and mortality compared to non-pregnant individuals. Additionally, research suggests that SARS-CoV-2 infection during pregnancy is linked to adverse pregnancy outcomes, such as preterm birth, preeclampsia, and stillbirth, as well as adverse neonatal outcomes, including hospitalization and admission to the neonatal intensive care unit. This review assessed the available literature from November 2021 to 19 March 2023, concerning the safety and effectiveness of COVID-19 vaccination during pregnancy. COVID-19 vaccination administered during pregnancy is not linked to significant adverse events related to the vaccine or negative obstetric, fetal, or neonatal outcomes. Moreover, the vaccine has the same effectiveness in preventing severe COVID-19 disease in pregnant individuals as in the general population. Additionally, COVID-19 vaccination is the safest and most effective method for pregnant women to protect themselves and their newborns from severe COVID-19 disease, hospitalization, and ICU admission. Thus, vaccination should be recommended for pregnant patients. While the immunogenicity of vaccination in pregnancy appears to be similar to that in the general population, more research is needed to determine the optimal timing of vaccination during pregnancy for the benefit of the neonate. [ABSTRACT FROM AUTHOR]

The growing interconnections among societies have facilitated the emergence of systemic crises, i.e., shocks that rapidly spread around the world and cause major disruptions. Advances in the interdisciplinary field of complexity can help understand the mechanisms underpinning systemic crises. This article reviews the most important concepts and findings from the pertinent literature. It demonstrates that an understanding of the nature of disruptions of globally interconnected systems and their implications is critical to prevent, react to, and recover from systemic crises. The resulting analytical framework is applied to two prominent examples of global systemic crises: the 2008 global financial crisis and the COVID‐19 pandemic. The article provides evidence that relying on reactive and recovery capacities to face systemic crises is not sustainable because of the extraordinary costs they impose on societies. Efforts are needed to develop a multipronged strategy to strengthen our capacities to face systemic crises and address fundamental mismatches between the nature of global challenges and the necessary collective action to address these challenges. [ABSTRACT FROM AUTHOR]

Objective: It has been noted that in different parts of the world there are a considerable number of people who have a negative attitude to coronavirus vaccines. Therefore, the possible causes of hesitancy and rejection towards COVID-19 vaccine have been found to be worth investigating. In this process, where fierce discussions have been raised, perceptions of marginalization of unvaccinated individuals were also evaluated. Methods: Study data were collected between November, 2021 and February, 2022. Participants were reached via social media. Within the scope of the study, semi-structured interviews were conducted with 14 participants. Interviews were conducted online or face-to-face. The data were analyzed by the method of inductive thematic analysis. Result: As a result of the analysis, it was found that the participants thought COVID-19 vaccines unnecessary, ineffective and/or risky. A number of participants have stated that COVID-19 vaccines may be part of larger goals. However, some participants reported that they felt pressure from their social environment and perceived negative attitudes. Conclusion: Considering vaccines unnecessary, ineffective and risky results in refusal to be vaccinated. It is seen that some of the participants have perceived of marginalization. It is recommended to provide accurate information about the disease and vaccination, to be transparent and to show an empathetic approach to these individuals. [ABSTRACT FROM AUTHOR]

Nigeria has been affected by the COVID-19 pandemic, and vaccination is a key strategy. However, the country faces vaccination hesitancy, poor risk perception, and low acceptance. This study aimed to assess the direct and interactive impacts of COVID-19 vaccine risk perception and acceptability on COVID- 19 vaccination attitudes in the general Nigerian population. In a cross-sectional approach, participants completed a structured questionnaire including demographics, COVID-19 vaccine risk perception, acceptance, and vaccination attitude from April 2-30, 2021. The sample included 1,026 participants from different ethnicities across four regions (Southwest, South, Southeast, and North Central) in Nigeria, which were selected using the convenience sampling method. Multivariate analysis of variance results showed that the COVID-19 vaccine’s risk perception and acceptability have separate and interactive effects on overall vaccination attitudes. Interactively, individuals with high-risk perceptions and low acceptance expressed more skepticism about its benefits, were concerned about its long-term body effects, believed more in its commercialization, and preferred natural immunity. Nigerians’ apprehension about COVID-19 vaccination is impacted by their high-risk perception and low vaccine uptake. [ABSTRACT FROM AUTHOR]

Background: Global COVID-19 vaccinations rates among youth and adolescent populations prove that there is an opportunity to influence the acceptance for those who are unvaccinated and who are hesitant to receive additional doses. This study aimed to discover the acceptance and hesitancy reasons for choosing or refusing to be vaccinated against COVID-19. Methods: A scoping review was conducted, and articles from three online databases, PubMed, Wiley, and Cochrane Library, were extracted and screened based on exclusion and PICOs criteria. A total of 21 studies were included in this review. Data highlighting study attributes, characteristics, and decision-making dynamics were extracted from the 21 studies and put into table format. Results: The results showed that the primary drivers for accepting the COVID-19 vaccine include protecting oneself and close family/friends, fear of infection, professional recommendations, and employer obligations. Primary hesitancy factors include concerns about safety and side effects, effectiveness and efficacy, lack of trust in pharmaceuticals and government, conspiracies, and perceiving natural immunity as an alternative. Conclusions: This scoping review recommends that further research should be conducted with adolescent and youth populations that focus on identifying health behaviors and how they relate to vaccine policies and programs. [ABSTRACT FROM AUTHOR]